HELLP syndrome

HELLP syndrome is a pregnancy-related condition and is an abbreviation for:

  • haemolysis
  • elevated liver enzymes and 
  • low platelets

It is considered a severe and life threatening form of pre-eclampsia although it can occur without co-existing pre-ecamplania. 

The estimated incidence is  ~0.5% (range 0.17-0.85%) of live births 9. The condition often occurs in the 3rd trimester of pregnancy (and occasionally post partum). It tends to present in young primigravid women. 

Presentation can be variable and can include malaise, epigastric/right upper-quadrant pain, and nausea/vomiting. Some may have nonspecific viral-like symptoms. Hypertension and proteinuria (classic symptoms of preeclampsia) may be absent or slight 7

The aetiology and pathophysiology remains incompletely understood with multiple theories 12:

  • immune-mediated: maternal acute rejection reaction to fetal antigens
  • placenta-mediated liver injury
  • systemic inflammatory response syndrome in the setting of pre-eclampsia
Histology

On liver histology, there is may a combination of deposited fibrin, haemorrhage and hepatocellular necrosis surrounding portal areas 6

Complications
CT

The place of CT is mainly to assess for complications. When considering a CT scan the radiologist needs to discuss with the obstetrician regarding radiation risk to fetus from radiation, versus clinical suspicion of a complications in order to make a rational judgement. The CT scan may show hepatic complications such as rupture, subcapsular haematoma or hepatic infarction.

Management is often supportive. Patients with hepatic rupture +/- intraperitoneal bleeding require immediate surgery or selective hepatic arterial embolisation

The condition was originally described Pritchard et al in 1954 3 with the acronym later coined by L Weinstein in 1982 4.

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Article Information

rID: 12561
Section: Syndromes
Synonyms or Alternate Spellings:
  • Haemolysis, elevated liver enzymes and low platelets
  • HELLP

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